Ramsdale Erika, Sanoff Hanna, Muss Hyman
From the University of Chicago Medical Center, Department of Medicine, Section of Hematology/Oncology, Chicago, IL; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, Chapel Hill, NC.
Am Soc Clin Oncol Educ Book. 2013:163-8. doi: 10.14694/EdBook_AM.2013.33.163.
The majority of new colorectal cancer diagnoses occur in adults 65 and older a rapidly growing segment of the U.S. population. Older adults are a markedly heterogeneous group, and although recent clinical trials in locally advanced colorectal cancer have incorporated limited numbers of older patients, the data can not be generalized to most older patients. In particular, patients who are not "fit"-those with poor functional reserve, major comorbidities, or who otherwise meet criteria for frailty or "prefrailty"-are poorly represented in published trials. Population-based data demonstrate that older adults are much less likely to be treated in the adjuvant or neoadjuvant settings for stage II/III colorectal cancer, but it is unclear what the basis should be for withholding potentially curative therapy. Age and Eastern Cooperative Oncology Group (ECOG) performance status (PS) are frequently used to determine eligibility for treatment, but data increasingly suggest these are inadequate; the emerging definition of a spectrum of "fit" to "frail" older patients may provide additional guidance. Available data suggest that fit older patients may benefit as much from curative-intent therapy as younger patients. For frail or vulnerable (prefrail) patients, on the other hand, the benefit must be carefully weighed against the risk of toxicity and competing risks from their comorbidities. Life expectancy and patient preferences should always be elucidated. Geriatrician comanagement may be helpful in determining priorities, providing a comprehensive assessment, and modifying competing risk factors. Even many vulnerable or frail patients can successfully complete (and derive benefit from) carefully considered treatment regimens.
大多数新诊断出的结直肠癌发生在65岁及以上的成年人中，这是美国人口中一个快速增长的群体。老年人是一个明显异质性的群体，尽管最近关于局部晚期结直肠癌的临床试验纳入的老年患者数量有限，但这些数据不能推广到大多数老年患者。特别是，那些“身体状况不佳”的患者——即功能储备差、有严重合并症，或符合虚弱或“准虚弱”标准的患者——在已发表的试验中代表性不足。基于人群的数据表明，老年人在II/III期结直肠癌的辅助或新辅助治疗中接受治疗的可能性要小得多，但尚不清楚不给予潜在治愈性治疗的依据是什么。年龄和东部肿瘤协作组（ECOG）体能状态（PS）经常被用来确定治疗的 eligibility，但数据越来越表明这些是不够的；“身体状况良好”到“虚弱”的老年患者范围的新定义可能会提供更多指导。现有数据表明，身体状况良好的老年患者可能从治愈性治疗中获得与年轻患者一样多的益处。另一方面，对于虚弱或脆弱（准虚弱）的患者，必须仔细权衡益处与毒性风险以及合并症带来的其他风险。应始终阐明预期寿命和患者偏好。老年医学专家共同管理可能有助于确定优先事项、提供全面评估以及改变其他风险因素。即使是许多脆弱或虚弱的患者也可以成功完成（并从中受益）经过仔细考虑的治疗方案。
